Mitigating Costs of Cancer Treatment: The Role of Pharmacists

Cancer care is associated with considerable financial toxicities, both in terms of out-of-pocket costs to patients and caregivers as well as burdens placed on the healthcare system at large.¹ Drug Topics® interviewed several experts to discuss the role of pharmacists in mitigating costs associated with cancer care.

The Cost of Cancer Care

According to Daniel Zlott, PharmD, senior vice president at the American Pharmacists Association (APhA), multiple aspects of cancer care can place several financial burdens on patients and their families. “Depending on the type of cancer a patient is being treated for,” he said, “it is not uncommon for patients to require frequent visits with their oncologist, to undergo one or more surgical procedures, and to receive a series of chemotherapy infusions or radiation treatments.”

In addition, Zlott noted that caregivers of patients with cancer also face potential financial burdens associated with their caregiver duties. “Cancer treatment can be just as demanding on caregivers who may also need to take time off from work to support their family member(s) as they go through treatment,” he said.

For patients who are still working, Zlott added, management of their cancer can quickly deplete leave and sick leave balances and may consequently result in loss of pay. “Also, the cancer treatments themselves may cause people to either feel unable to work or, depending on their work responsibilities and the type of treatment the patient is receiving, may make it unsafe for them to work,” he added.

Lisa Holle, PharmD, clinical professor in the School of Pharmacy at University of Connecticut, and member of the Drug Topics® Editorial Advisory Board, echoed these statements and indicated that the largest financial toxicity that patients with cancer face is the costs of anticancer drugs. “Even if they have prescription drug insurance, co-pays or deductibles can result in significant costs,” Holle explained.

According to Holle, the average out-of-pocket costs for nearly all orally administered anticancer drug therapies is approximately $10,000 per month. “Most of our newer therapies that are administered intravenously are multi-thousands of dollars per treatment,” she said. Chimeric antigen receptor T-cell therapy is one of more expensive therapies, Holle added, although the “overall costs of long-term cancer care could be lower if no further treatment is needed.”

Alexandre Chan, PharmD, of the school of pharmacy and pharmaceutical sciences at the University of California, Irvine, said in a phone interview with Drug Topics® that many of the diagnostics used in cancer care also carry significant costs. “Some insurance plans may not even pay for some of those activities,” he explained.

Additionally, Chan noted that the management of certain symptoms, such as neuropathy, can also contribute considerably to the financial impact of cancer care. “We don't really have a lot of very good medications for managing a lot of the symptoms that patients are experiencing,” he added. Some integrative and complementary approaches to symptom management, like acupuncture, may not be covered by insurance plans, given that the evidence for these approaches is not as strong as the data available for regulated medications.

How Financial Toxicities Impact Patients With Cancer

The financial impact of cancer treatment can be highly varied and is dependent on the individual patient’s circumstances, Zlott explained. “At one end of the spectrum is an individual with excellent insurance and a workplace with policies that are highly supportive of people who are experiencing serious illness,” he said. “At the other end of the spectrum are individuals without insurance, and without work, or who work for an employer that is unable or unwilling to extend support to its employees going through serious illness.”

Direct financial impacts of cancer treatment range from changes in lifestyle, such as reducing spending on recreational activities and vacations, to more severe issues such as inability to pay day-to-day bills due to the costs of cancer care, Zlott added.

Patients who are waiting to see if they can afford their treatment and/or if they meet qualifications for company-sponsored assistance or foundation assistance can also experience delays and interruptions in care, potentially jeopardizing clinical outcomes, Holle added. And if a patient does qualify for financial assistance, “There is often a period within each year where they have to reapply, [where] funds in the program may run out temporarily, or [where] they have to meet some criteria for insurance, which can interrupt care,” Holle said. “Financial toxicity of a regimen may prevent a patient from receiving that regimen if they cannot afford [it] and no financial assistance is available, so that might require [the] patient to have another treatment option.”

Furthermore, the high costs associated with cancer treatments can lead to impairments in mental/emotional health, contributing to the overall burden of the disease and its management.² “It is also important to consider the mental stress or strain that these types of financial situations place on people with cancer and their families,” Zlott added. “This strain can result in mental health conditions, such as anxiety and depression, which should also be screened for and addressed by the patient’s care team.”

What Pharmacists Can Do

The most important thing a pharmacist can do to help mitigate cancer care costs is to help patients identify the lowest cost options available. However, he pointed out, in “many instances, there aren’t many choices available due to lack of available generic medications or less expensive treatment options.”

In these instances, pharmacists can work with patients to help find prescription assistance programs, point them to charitable foundations that help patients with cancer, and refer them to “other members of the health care team, such as social workers, who can further assist patients in addressing the financial burdens associated with cancer care.”

Holle added that pharmacy technicians can also work with pharmacists to assess patients’ financial needs and determine availability of and eligibility for financial assistance programs to cover care or replacement drugs. Pharmacists can also try to minimize time in the infusion room for treatment so patients can get back to their normal routine, which may help with reducing time spent outside of work. Also, she suggested that pharmacists can seek to become more involved in developing pharmacy and therapeutics formulary recommendations and/or clinical pathways that better consider treatment-related financial burdens.

Utilizing biosimilars in addition to generic medications may also help decrease total costs of cancer care, Zlott noted. “Seeking prior authorization from a patient’s insurance company can also have a large impact on the out-of-pocket cost of care for a patient if the prior authorization is approved,” he added. “While these interventions certainly help, they are not enough to help lessen the total cost of cancer care for many patients.”

Many oncology pharmacists can provide first-time chemotherapy counseling and, instead of solely focusing on the costs of drugs, can seek to focus on how best to manage disease- and treatment-related symptoms in a cost-effective way, Chan added. “Focusing on if patients are even telling you that they have financial issues or that they have other distress that they need help with is [also] important. At least we are able to address them as a bigger whole, rather than just focusing on very rudimentary side effects.”

Multidisciplinary Approaches

The multidisciplinary care team serves as a coordinated, collaborative source of care that works to ensure all needs of the patient are addressed, including concerns surrounding the costs of and access to treatment. “Pharmacists work with the care team to identify and address the adverse events associated with cancer care as quickly as possible to ensure that patients have the best possible quality of life while undergoing cancer treatment,” Zlott explained.

Given that medications can contribute significantly to the total cost of cancer care, pharmacists are “well positioned to be able to identify options that may be available to help a person with cancer” while communicating any relevant financial concerns to other members on the care team,” Zlott said.

“When a pharmacist is involved in a multidisciplinary team and they are working together in providing care, they can provide guidance and recommendations that are cost-effective and provide reduced financial burden to the patient,” said Holle. “By performing medication reconciliation, they can identify potential medication-related problems and offer solutions with the idea that they will prevent additional health care issues and thus cost.”

Pharmacists, she added, along with other clinicians, can ensure financial offers and social workers are involved to help relieve the financial burden that occurs beyond the costs of medications.

Improving communication may also be crucial, said Zlott. “I think the most important point for people with cancer is to be open with their care team about the financial impact their cancer care has on them,” he said. “There are many tools and resources that the care team has available to assist patients who are experiencing financial challenges, but the care team can’t help if they don’t know that the patient is experiencing financial challenges.”

References

1. Iragorri N, de Oliveira C, Fitzgerald N, Essue B. The out-of-pocket cost burden of cancer care-a systematic literature review. Curr Oncol. 2021;28(2):1216-1248. doi:10.3390/curroncol28020117

2. Essue BM, Iragorri N, Fitzgerald N, de Oliveira C. The psychosocial cost burden of cancer: a systematic literature review. Psychooncology. 2020;29(11):1746-1760. doi:10.1002/pon.5516